What’s going on at qd Solutions and rattling around in our brains

When I hear the words “social media,” I immediately think, ah, yes, the grown-up words for Twitter, Facebook, and YouTube (sorry, MySpace, wherever you have gone). Then, out of fear I’m being culturally left behind, I immediately run to all three to make sure I haven’t missed my favorite writer’s take on whatever event has just occurred, a friend posting a snippet of the minutiae of everyday life, or the latest video involving a cat, a toaster, and some circus music. And I’m not alone in the way I view and use these forms of social media, as most people I know think of them as entertainment and a way to stay socially relevant.

While social media certainly is those things, we often forget the one idea behind social media that makes it so powerful: It offers anyone, no matter who you are or where you are, a chance to be connected to others and feel like you matter. As we are creatures who need social interaction and are always looking to be accepted, no matter how independent one is, it shouldn’t come as surprise that social media has exploded in popularity and use like it has. But can this desire for personal connection be effectively used in an area like clinical trials?

The Pew Research Center recently conducted a study in which it was revealed that 61% of American adults seek medical information online. That’s a lot of people looking for information with which they’re not very familiar. It’s also a lot of information that needs sorting. And it’s also the opening for social media.

These people, like you and me, can be confused, worried, and frustrated as they search online. But, while they all have different concerns, all of them want someone to point them in the right direction. Someone to tell them, “Hey, check out this link” or “This might be helpful to you.” Whether they realize it or not, they want human interaction.

Social media provides such interaction. It allows individuals to interact on a personal level, and, in the case of relaying medical information, as long as the information provided is useful and accurate, it helps build trust. By using social media, through a Facebook page or Twitter account for example, clinical trials can connect on a personal level with prospective patients, while providing them with valuable information. And it’s probably safe to assume that the more trust a prospective patient has in a clinical trial, the more likely he or she is likely to enroll.

Of course, relying totally on social media for patient recruitment is and may never be prudent (someone write that down and remind me of that sentence when social media becomes our overlords in 5-10 years). In fact, the FDA has yet to release guidelines on how clinical trials may use social media to recruit patients. For now though, when used and taken in moderation, like all things, social media has a proper place in patient recruitment. But I’d save the video of the cat making toast set to circus music for family and friends.

Me (for the tenth time): “Dad, I create ads to help recruit people into medical research studies so potential, new medicines can be developed.”

Dad: “Did you do those beer commercials? They’re dumb.”

It’s another thing when your peers in the advertising industry don’t really understand what I do.

Me: “We create campaigns to motivate people to consider participation in clinical trials.”

Ad Friend: “Cool. Like Viagra?”

Like most artists, creative-types in the ad industry like recognition. That means winning an award for your work. Most ad award programs are very broad. You’re going up against creative for companies like Nike, ESPN, Coke and Budweiser, which is why advertising campaigns for clinical trials are not going to do well against the competition. Most award judges, who are peers from the broad ad industry, don’t get what we do. They don’t understand how pharmaceutical lawyers, government regulations, and overall medical ethics create a narrow canvas from which to work. “It can’t be funny, why?” they ask me.

Finally, though, someone gets what we do. This article from CenterWatch discusses the challenges of creating ads for clinical trials and how a couple of the premier shows in the pharmaceutical advertising community are awarding campaigns that focus on medical research. We’re honored to be mentioned. Perhaps I’ll show my dad.

Posted by qd_admin on February 18th, 2011 :: Filed under Uncategorized

I was struck by a recent Applied Clinical Trials article by Ken Getz about the IRB system and the need for reform. In the article, Ken talks about the rejection of a patient education brochure by an IRB because the word “hope” was used in the document. According to the IRB, it’s coercive.

Unfortunately, it wasn’t a big surprise. As an ad agency that develops patient recruitment materials for CROs and sponsors, we know that words like “hope” are a big no-no with regulators. The belief is if we explicitly say “hope,” then people will make enrollment decisions based on that rather than facts. And yet I’ve seen in focus groups that patients understand that there are no guarantees with medical research. Just to make sure, we say exactly that in our recruitment materials. It’s also why we don’t use the word “cure.”

Still, removing the word from recruitment materials doesn’t make it go away with study participants. Plus the industry, which the regulators are part of, don’t want it to.

Largely, clinical trials are about hope for patients — the hope that the investigational medication does something that’s more positive than their current treatment. And sponsors support this with protocol inclusion criteria that many times require patients to be struggling with or failing their current, approved treatment. For the most part, patients participate in studies specifically to counter what the inclusion criteria ask for.

To assume that by not actually using the word “hope” that patients won’t have it is false. Someday, regulators (along with legal counsel) will be comfortable with the idea that hope is implied whether we say it or not. Rather than hiding the word, we can bring hope out front with our patients, and bask together in it. Recruitment and the drug development process will be better for it.

This is a great article from the Wall Street Journal about a new approach to clinical trials called “adaptive design.” It allows researchers to look at study results much earlier in the process, enabling researchers to steer later-enrolling patients into studies where they may receive the most medical benefit based on the genetic profile of their disease. It’s a more personalized version of clinical research, which, as it expands, will have a positive effect on the image of clinical trials among prospective patients.

Earlier this year, a good friend of mine had appendicitis. During his time in the emergency room, he received a CAT scan, which confirmed the diagnosis, and he went into surgery.

The day he checked out of the hospital, his doctor came by. While the appendectomy had gone well and my friend was healing well, the doctor had additional news – in addition to the appendicitis, the CAT scan had also revealed a spot on one of his kidneys. Was it a tumor? The doctor recommended he follow-up on it and referred him to another doctor.

In a recent article (and follow-up editorial) in the Archives of Internal Medicine, found here, the question was raised whether medical research participants should be notified of “incidental findings” that turn up on radiological reports but are unrelated to the research study’s intent. Say you’re in a heart study and a chest scan (as required by the study’s protocol) indicates a spot on one of your lungs. The debate was whether you should be told about the lung finding. Maybe the person reading the radiology results isn’t really qualified to interpret them beyond the study parameters. Or perhaps it’s a false-positive that will give you unneeded stress and require many other tests, which come with their own risks to you. So, should you be told?

Are you kidding me?

One of the hesitations that people have about participating in clinical trials is the perception that the research is not really interested in the patient’s health, but rather in getting the data about the investigational medicine. This is largely untrue. But even to question the true motive hints that perception might sometimes be reality in this case.

While the primary purpose of medical research is gaining information about the investigational treatment, patients should feel (and truly realize) that they are getting the highest level of medical care by volunteering. To suggest otherwise only undermines efforts to get more people to participate in medical research. There should be no dilemma here – the patient should be told of the findings and provided resources for follow-up. That extra bit of health security will only enhance the medical research experience in the eyes of the public.

As for my friend, thank goodness the doctor did say something. It was a tumor on his kidney, necessitating more surgery. Because of the appendicitis (it could have just as easily been an incidental finding in a clinical trial test), the tumor was caught early and my friend is now making a full recovery.

Here is an interesting article from today’s New York Times. It just further demonstrates that through continued research comes new discoveries which could end up leading to more efficient treatment options in the future.

Recently the U.S. Food and Drug Administration (FDA) announced the “Bad Ad Program,” an effort to have doctors and healthcare professionals around the country report what they believe to be misleading drug ads.

Evidently, the initiative is to help the FDA’s understaffed and overwhelmed Division of Drug Marketing, Advertising and Communications (DDMAC) with more surveillance of the large volume of direct-to-consumer (DTC) promotional materials that makes its way to consumers and medical personnel every day. The measure has been largely panned in the drug advertising community as too broad, lacking in education, and questions its ability to overcome biased reporting from doctors who are already anti-DTC.

While “bad ads” do seem to be the stated battle, it appears the real concern is the way drugs are marketed that the FDA can’t see (i.e. detailing by reps to doctors behind closed doors, comments made at medical conferences, etc.) where false claims, overstated results, off-label promotion, and understated risks can be made.

Within the patient recruitment industry, there are Institutional Review Boards (IRBs), per FDA regulations, to review and approve promotional recruitment materials. However, with dozens of IRBs reviewing patient-facing recruitment materials, experience suggests that while some IRBs won’t approve certain language in recruitment materials, others will approve it with no changes. Those inconsistencies invite complaints and governmental review. Being a part of this industry for more than 14 years, I’ve seen recruitment materials overly promote the monetary benefits of study participation (i.e. visuals of dollar signs) and make promissory statements about the investigational treatment.

No doubt the vast majority of pharmaceutical DTC marketing is done within FDA requirements. Like most things in life, though, a couple of bad apples ruin it for everyone else trying to gain some false competitive edge. The same could certainly occur in the patient recruitment industry, where competition for medical research study patients can be fierce. All it takes is one ill-timed, unethical, unapproved (and arguably uneducated) recruitment ad to generate complaints that invite government scrutiny. Without a consistently high level of self-policing among patient recruitment agencies and sites, the industry may find itself also under the interrogation spotlight.

Friends who know I work with the pharmaceutical industry quiz me often about what healthcare reform means for our business. It’s a loaded question, and one that can generate a slew of follow-up questions.

Here’s what I know: According to the Center for Information and Study on Clinical Research Participation (www.ciscrp.org) and the US Census, National Vital Statistics, new medicines generated 40% of the gain in life expectancy over the past 25 years. That’s a lot when you think how much health-conscious the country has become during that time, with reductions in smoking, increased exercise, and better overall health education. And yet according to annual data for 2006 compiled by the Centers for Medicare and Medicaid Services (CMS), just 10 cents of every dollar (or 10%) spent on health care went to medicines.

That’s quite a disparity. Does that mean they should be equal – more of the healthcare dollar should be spent on medicines to match its impact on life expectancy? Of course not. But the value of new medicines and their impact on the quality of our lives shouldn’t be dismissed in the process.

So what will healthcare reform, in whatever “form”, ultimately mean for us? It’s hard to say. Given the gains in life expectancy, I’m not sure why anyone would want to make it harder for people to develop new medicines. Yes, drug companies need to discover new medicines because it’s the product they sell. But more than that, the clients we work with are good people. They have families who are impacted (and sometimes devastated) by health issues just like everyone else. They come to work every day not thinking only about the dollar, but thinking about the people they’ll someday help – children and adults who want to live longer, normal, healthy lives. And no amount of legislation will ever change that.

Within the vast advertising community, it’s often difficult to convey what we do as an ad agency. Heck, my father still doesn’t really understand what I do. Our agency doesn’t create funny beer ads, or promote a cool sports line. We don’t hype banks or help sell food. And while our clients are in the pharmaceutical industry, we don’t work on approved drugs. What we do, I think, is far more challenging.

We work 24/7 to develop compelling ad campaigns that recruit the general public into medical research studies. We must convince people that the future of medicine depends on their participation in a clinical trial with an “investigational medication” that has not been approved by a country’s drug review agency (i.e. the FDA). If that’s wasn’t hard enough, we must be compelling within a legal and regulatory box that most agency-types would find ridiculously-limiting to the creative process. In pharmaceutical communications world, patient recruitment advertising is not the “coolest” of creative spaces.

So we were humbled and honored last month when we won two prestigious awards at the international Rx Club Show.

Established to honor worldwide pharmaceutical product advertising and promotion, The Rx Club Show is judged in various categories by a panel of industry experts and is based solely on creativity.

You’ll see that most all of the winners are for campaigns promoting approved medications – that’s generally where the big agencies (and the big budgets) hang-out. By our count, we were the only agency to win based on work in the patient recruitment advertising niche. Pretty cool for us. Even better for the patient recruitment industry.

Two big developments in the pharmaceutical world of social media. Here we are today with the first qd blog entry, while at the same time the FDA is holding a hearing on the use of the internet and social media in the promotion of approved medical products.

Since we live in the “pre-approval” medical products space of patient recruitment for clinical trials, we’re all hoping for some guidance that can help us as well. We’ve heard from focus groups that the public wants quick, easy-to-find information about medical research studies. The challenge, of course, is how to do that within the confines of IRB approval, where all content targeting potential patients must be approved well in advance.

Study websites are on the rise with sponsors, and are fairly easy to create within the confines of the IRB. But the instant gratification of social media makes everyone in the clinical trial industry nervous. And yet, social media is not only the new marketing frontier, it provides the constant stream of information that society has come to expect, and arguably, deserves.

If the interest in open communication about clinical research is truly sincere, don’t we owe the public the information they want in a timely manner? And if the results are stronger participation in clinical research, and thus more effective drugs brought to market more quickly, don’t we all win?